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A Clinical Decision Rule to Identify Infants With Apparent Life-Threatening Event Who Can Be Safely Discharged From the Emergency Department.
MedLine Citation:
PMID:  22743742     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: This study aimed to formulate a clinical decision rule (CDR) to identify infants with apparent-life threatening event (ALTE) who are at low risk of adverse outcome and can be discharged home safely from the emergency department (ED). METHODS: This is a prospective cohort study of infants with an ED diagnosis of ALTE at an urban children's hospital. Admission was considered warranted if the infant required significant intervention during the hospital stay. Logistic regression and recursive partitioning were used to develop a CDR identifying patients at low risk of significant intervention and thus suitable for discharge from the ED. RESULTS: A total of 300 infants were enrolled; 228 (76%) were admitted; 37 (12%) required significant intervention. None died during hospital stay or within 72 hours of discharge or were diagnosed with serious bacterial infection. Logistic regression identified prematurity, abnormal result in the physical examination, color change to cyanosis, absence of symptoms of upper respiratory tract infection, and absence of choking as predictors for significant intervention. These variables were used to create a CDR, based on which, 184 infants (64%) could be discharged home safely from the ED, reducing the hospitalization rate to 102 (36%). The model has a negative predictive value of 96.2% (92%-98.3%). CONCLUSIONS: Only 12% of infants presenting to the ED with ALTE had a significant intervention warranting hospital admission. We created a CDR that would have decreased the admission rate safely by 40%.
Authors:
Manoj K Mittal; Guoying Sun; Jill M Baren
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-28
Journal Detail:
Title:  Pediatric emergency care     Volume:  -     ISSN:  1535-1815     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8507560     Medline TA:  Pediatr Emerg Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the *Division of Emergency Medicine, The Children's Hospital of Philadelphia; †Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; ‡Biostatistics, CHOP-Westat Biostatistics and Data Management Core; §Department of Emergency Medicine, Hospital of the University of Pennsylvania; and ∥Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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